This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ammash, N. M. Articles by Warnes, C. A. Search for Related Content PubMed PubMed Citation Articles by Ammash, N. M. Articles by Warnes, C. A.

CLINICAL STUDIES

Noncardiac surgery in Eisenmenger syndrome

^a Department of Anesthesiology, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA

Manuscript received April 30, 1998; revised manuscript received August 11, 1998, accepted September 10, 1998.

Address for correspondence: Dr. Naser M. Ammash, Senior Associate Consultant, Division of Cardiovascular Diseases and Internal Medicine, West 16B, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
ammash.naser{at}mayo.edu

Objectives. The purpose of this study was to evaluate the morbidity and mortality associated with noncardiac surgery (NCS) in patients (pts) with Eisenmenger syndrome.

Background. Noncardiac surgery in pts with Eisenmenger syndrome is associated with increased cardiovascular complications.

Methods. Fifty-eight pts with Eisenmenger syndrome (17M, 41F aged 18 to 69 years (mean 41 years) who had been followed for up to 41.5 years (mean 9.3 years) were retrospectively evaluated for any NCS done at 17 years of age.

Results. Twenty-four pts had a total of 28 NCSs at an age of 17 to 55 years (mean 29 years) including 9 tubal ligations, 3 neurosurgeries, 3 cholecystectomies, 3 hysterectomies, 3 vasectomies, and 1 each spinal fusion, appendectomy, eye enucleation, hernia repair, hand surgery, tonsillectomy and therapeutic abortion. There were two deaths (7%), one following spinal fusion and the other following appendectomy at another institution.

Fourteen of these NCSs were performed at our institution, including 11 under general anesthesia. The duration of anesthesia varied from 75 to 525 min (mean 165 min). All pts remained in sinus rhythm. The lowest systolic blood pressure (BP) ranged from 78 to 125 mm Hg. Of those 11 pts, 9 were extubated immediately after surgery and 2 needed dopamine. Ten patients were discharged without any complications, including 3 within 1 day of surgery. One death occurred 10 days following spinal fusion. This pt had the longest anesthesia (525 min) and an intraoperative systolic BP as low as 78 mm Hg. She also needed the largest fluid administration (6,475 cc) in addition to postoperative mechanical ventilation and dopamine.

Conclusions. Adult pts with Eisenmenger syndrome are at increased risk with NCS, but with current/modern techniques, the risk of death is less than previously thought. In the vast majority of cases, NCS can be undertaken without substantial morbidity, and early extubation is achievable. However, even with relatively minor surgery, significant complications, including death, can occur. Referral to major centers with expertise in the care of pts with Eisenmenger syndrome is advisable.

Abbreviations and Acronyms   NCS = noncardiac surgery   pts = patients

This article has been cited by other articles:

				J. E. Deanfield, R. Yates, F. J. Meijboom, and B. J.M. Mulder CHAPTER 10 Congenital Heart Disease in Children and Adults ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): e143 - e263. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): 1890 - 1947. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): e714 - e833. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): 2395 - 2451. [Full Text] [PDF]

				A. O. Famuyide, M. R. Hopkins, S. A. El-Nashar, D. J. Creedon, G. M. Vasdev, D. J. Driscoll, H. M. Connolly, and C. A. Warnes Hysteroscopic Sterilization in Women With Severe Cardiac Disease: Experience at a Tertiary Center Mayo Clin. Proc., April 1, 2008; 83(4): 431 - 438. [Abstract] [Full Text] [PDF]

				G.-P. Diller and M. A. Gatzoulis Pulmonary Vascular Disease in Adults With Congenital Heart Disease Circulation, February 27, 2007; 115(8): 1039 - 1050. [Abstract] [Full Text] [PDF]

				P. Khairy, N. Poirier, and L.-A. Mercier Univentricular Heart Circulation, February 13, 2007; 115(6): 800 - 812. [Abstract] [Full Text] [PDF]

				M. U. Fischer and H.-J. Priebe Anaesthetic management for hip arthroplasty in a 46-yr-old patient with uncorrected truncus arteriosus type IV Br. J. Anaesth., September 1, 2006; 97(3): 329 - 332. [Abstract] [Full Text] [PDF]

				A. T. Lovell Anaesthetic implications of grown-up congenital heart disease Br. J. Anaesth., July 1, 2004; 93(1): 129 - 139. [Abstract] [Full Text] [PDF]

				A. F. Corno, P. Tozzi, C. Y. Genton, and L. K. von Segesser Surgically induced unilateral pulmonary hypertension: time-related analysis of a new experimental model Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 513 - 517. [Abstract] [Full Text] [PDF]

				N. M. Ammash and C. A. Warnes Ventricular Septal Defects in Adults Ann Intern Med, November 6, 2001; 135(9): 812 - 824. [Abstract] [Full Text] [PDF]

				J. Hofland, I. Gultuna, and R. Tenbrinck Xenon anaesthesia for laparoscopic cholecystectomy in a patient with Eisenmenger's syndrome{{dagger}} Br. J. Anaesth., June 1, 2001; 86(6): 882 - 886. [Abstract] [Full Text] [PDF]

				E. Foster, T. P. Graham Jr., D. J. Driscoll, G. J. Reid, J. G. Reiss, I. A. Russell, M. Sermer, S. C. Siu, K. Uzark, R. G. Williams, et al. Task Force 2: special health care needs of adults with congenital heart disease J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1176 - 1183. [Full Text] [PDF]

				J. Previte and P. Haran Eisenmenger Syndrome Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2001; 5(1): 67 - 78. [Abstract] [PDF]

				B.M Weiss and O.M Hess Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives Eur. Heart J., January 2, 2000; 21(2): 104 - 115. [PDF]

				K. Niwa, J. K. Perloff, S. Kaplan, J. S. Child, and P. D. Miner Eisenmenger syndrome in adults: Ventricular septal defect, truncus arteriosus, univentricular heart J. Am. Coll. Cardiol., July 1, 1999; 34(1): 223 - 232. [Abstract] [Full Text] [PDF]